Are Rural Older Adults Benefitting from Increased State Spending on Medicaid Home and Community-Based Services?

Authors

Andrew F. Coburn PhD, University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research CenterFollow
Eileen Griffin JD, University of Southern Maine, Muskie School of Public Service
Deborah Thayer MBA, University of Southern Maine, Cutler InstituteFollow
Zachariah T. Croll MPH, University of Southern Maine, Maine Rural Health Research CenterFollow
Erika C. Ziller PhD, University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research CenterFollow

Document Type

Article

Publication Date

6-2016

Keywords

Rural, Medicaid, Home and Community-Based Services, HCBS, Elderly, MRHRC, LTSS, USM Aging Initiative, Health and Wellness

Abstract

In a shift away from institutional long term services and supports (LTSS), the federal government and states have pursued an array of strategies for expanding access to home and community-based services (HCBS) over the past few decades. Yet, little is known about variations in the availability or use of Medicaid HCBS within states, across rural and urban areas. This study used the national Medicaid Analytical Extract claims data file (2008) to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS. The study found that rural Medicaid LTSS users were less likely to receive HCBS and more likely to receive nursing facility services than their urban counterparts. The proportion of LTSS spending for nursing facility services was significantly greater among rural than urban LTSS users and expenditures for personal care, home health, hospice, adult day care, and rehabilitation were all significantly lower for rural LTSS users compared with those living in urban areas. Multivariate analyses showed that beneficiary characteristics alone do not explain the observed rural-urban differences in HCBS use and expenditures. State policies and other factors such as urban and rural differences in the availability and supply of HCBS and nursing facility services, are likely important contributors to differences in HCBS use and expenditures.

Funding Organization

Federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS

Grant Number

CA#U1CRH03716

Recommended Citation

Coburn, A., Griffin, E., Thayer, D. A., Croll, Z., & Ziller, E. C. (2016). Are rural older adults benefiting from increased state spending on Medicaid home and community-based services? (PB-65). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.